a client who had an elective below the knee amputation reports pain in the foot that was amputated what is the best response by the nurse
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Nursing Elites

ATI RN

Multi Dimensional Care | Final Exam

1. A client who had an elective below-the-knee amputation reports pain in the foot that was amputated. What is the best response by the nurse?

Correct answer: D

Rationale: The correct response is to assess the pain intensity by asking the client to rate their pain on a scale of 0-10. This helps the nurse to effectively manage the client's pain. Choice A is incorrect as it dismisses the client's pain without proper assessment. Choice B is incorrect as it assumes the pain is phantom limb pain without assessing the client's current condition. Choice C is incorrect as it invalidates the client's pain experience and does not address the issue at hand.

2. The nurse Is teaching the client how to administer eye drops. Which of these actions indicates the need for further client education?

Correct answer: D

Rationale: Touching the dropper to the eye contaminates it and can lead to infection.

3. A nurse is caring for an immobile client. What is the priority assessment in this client?

Correct answer: A

Rationale:

4. What is accurate health promotion teaching to prevent ear infection or trauma? (Select all that apply)

Correct answer: D

Rationale: The correct health promotion teachings to prevent ear infection or trauma include blowing the nose gently without blocking nostrils, wearing hearing protection when exposed to loud noise, and avoiding the use of cotton-tipped applicators to clean the external ear. Blocking one nostril when blowing the nose is incorrect, as it can cause problems. Therefore, choice A is inaccurate. Additionally, using cotton-tipped applicators to clean the external ear can lead to trauma or infection, making choice C a correct preventive measure.

5. The client is at risk for impaired skin integrity related to the need for several weeks of bedrest. The nurse evaluates the client after 1 week and finds skin integrity is not impaired. In evaluating the plan of care, what is the nurse's best action?

Correct answer: D

Rationale:

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